Systems for homogeneous immunoassays for multiple allergens

ABSTRACT

A homogeneous immunoassay method and system for quantitative determination of total immunoglobulin E and specific antibody levels to a plurality of allergens, in which a relatively small sampling of blood is required. The method utilizes relatively small microparticles in aqueous suspension. The immunoassay procedure is an immunometric sandwich procedure preferably utilizing biotin-streptavidin signal amplification techniques and R-phycoerytherin fluorescent labels.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.12/316,838, filed Dec. 16, 2008, now U.S. Pat. No. 7,892,853, which is acontinuation of U.S. application Ser. No. 11/786,193, filed Apr. 10,2007, now U.S. Pat. No. 7,491,553, which is a continuation of U.S.application Ser. No. 10/387,790, filed Mar. 12, 2003, now abandoned,which is a continuation-in-part of U.S. application Ser. No. 10/006,483,filed Dec. 6, 2001, now abandoned; and, each of these applications isincorporated herein in its entirety by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to a homogenous immunoassay method and a systemfor determining specific antibody levels to a multiplicity of allergensfrom a blood sample, or for determining total immunoglobulins E levelsin such a sample, for the purpose of diagnosing allergy.

2. Background and Prior Art

“Allergy” is synonymous with atopy or hypersensitivity and is the resultof an immunologically mediated reaction by individuals to variousantigenic materials, known as allergens. People with allergies produceallergen-specific immunoglobulins, IgE and IgG, in response to exposureto normally harmless substances from pollens, molds, dander or foods,which are inhaled or ingested. The generated antibodies are released tocirculate in the blood and eventually fix to specific cells in tissue.Exposure to allergens generally results in immediate or delayedreactions, manifested in a number of commonly identifiable symptoms,such as sneezing, itchy eyes, runny nose and inflammation of the lungsand nasal passages. The term “allergy” is also generally synonymous withhay fever, rhinitis, eczema, hives, and linked to the onset of asthma.The diagnosis of allergy involves a review of the patient history,physical examinations and running a confirmatory diagnostic test toidentify whether the patient's symptoms are of allergic or non-allergicorigin. If allergy is responsible for the symptoms, then the allergensresponsible must be identified. Patients with atopic or allergicdiseases may be mono-sensitive to one allergen; however, sensitizationto multiple allergens is more usual. Reactions of persons to allergenscan range from the annoying to the severe or even fatal. It therefore isdesirable to be able to determine not only whether a person hasallergies, but if so, to what allergens and to what level of severity,so that exposure can be avoided, minimized or mitigated throughpharmacotherapeutic or immunotherapeutic methods

Confirmatory diagnostic testing may be conducted by in-vivo skintesting, in-vivo provocation testing, or in-vitro testing for thepresence of circulating allergen-specific antibodies from blood samples.Direct provocation, by direct inhalation or ingestion of possibleoffending allergens, while relevant, is unpleasant, possibly dangerousand cannot be performed for multiple allergens at one sitting.

Skin testing (also referred to as skin prick testing or scratch testing)is an in vivo procedure that involves applying an allergen sample, ormore generally a multiplicity of allergens, directly to a patient'sforearm or back via a small needle scratch and measuring the size of theinflammatory reaction (wheal) at the applied site on the skin. Skinprick testing is widely used, is reliable under optimal testingconditions, can be painful, is subject to large differences in techniqueand interpretations, and cannot be used on patients taking certain drugsor patients with skin problems. Furthermore, both provocation and skinprick in-vivo diagnostic methods have the potential for sensitizingpatients to new allergens and, in extreme cases, eliciting alife-threatening anaphylactic reaction upon direct exposure to theoffending allergen(s).

In vitro diagnostic testing methods directly measure circulating levelsof allergen-specific antibodies in a sample of blood obtained frompatients. These methods are generally immunoassay procedures that arereproducible, are equivalent in sensitivity and specificity to wellconducted skin prick tests, are unaffected by any of the factors whichprevent the use of either of the two in vivo methods, and do not causeanaphylactic events. Immunoassay techniques capable of measuringspecific antibody levels to single allergens have been employed for manyyears (Johansson, S. G. O. and Yman, L., In vitro assay forimmunoglobulin E, Coin. Rev. Allergy 6, 93-139, 1988). Alternatively,methods that measure allergen-specific levels to a plurality ofallergens simultaneously have provided more useful screenings of allergyas, for example, described in U.S. Pat. Nos. 4,459,360 and 5,082,768.U.S. Pat. No. 6,087,188 describes a method of detecting an antibody in asample using paramagnetic particles and a chemiluminescent acridiniumcompound bound to avidin or streptavidin. The method described in thispatent is stated to be useful for the detection of allergens. However,the method is limited to detection of a single allergen in a givensample.

In the field of clinical diagnostics there is a broad category ofmethods available for determining an expanding list of clinicallyrelevant analytes. One such category is immunoassays, which arecurrently used to determine the presence or concentration of variousanalytes in biological samples, both conveniently and reliably (TheImmunoassay Handbook, edited by David Wild, M Stockton Press, 1994).Immunoassays utilize specific binding agents to target analytes influids, where at least one such binding agent is generally labeled witha variety of compounds, including radioisotopes, enzymes and fluorescentor chemiluminescent compounds, that can be measured by radioactivedisintegrations, enzymatic induced color-producing substrates,fluorescent output or inhibition and chemiluminescent light output. Suchspecific binding agents typically include analyte specific antibodies(immunoglobulins) and antibody fragments, receptors, lectins, andgenetically or chemically engineered artificial antibodies. Notableimmunoassay methods include, for example, radioimmunoassay (RIA),enzyme-linked immunosorbent assay (ELIZA) (Enzyme-Immunoassay, Edward T.Maggio, CRC Press, 1980), fluorescent immunoassay (FIA) andchemiluminescent assays (CLA) (Luminescent Assays, Perspectives inEndocrinology and Clinical Chemistry, Vol. 1, Mario Serio and MarioPazzagli, Raven Press, 1982), (Bioluminescence and Chemiluminescense,Basic Chemistry and Analytical Applications, Marlene, A. DeLuca andWilliam D. McElroy, Academic Press, 1981), (Journal of Bioluminescence,Vol. 4, M. Pazzagli, et al., Proceedings of the Vth InternationalSymposium on Bioluminescence and Chemiluminescence, Wiley, 1989), etc.Numerous method variations and devices for performing such assays areavailable, are known to those familiar with the art, and can be found inthe scientific and patent literature.

Immunoassays may be heterogeneous or homogeneous. Heterogeneousimmunoassays have been applied to both small and large molecular weightanalytes and require separation of bound materials (to be detected ordetermined) from free materials (which may interfere with thatdetermination). Heterogeneous immunoassays may comprise an antibody oran antigen immobilized on solid surfaces such as plastic microtiterplates, beads, tubes, or the like or on membrane sheets, chips andpieces of glass, nylon, cellulose or the like (Immobilized Enzymes,Antigens, Antibodies, and Peptides, Howard H. Weetall, Marcel Dekker,Inc., 1975). In heterogeneous immunoassays, antigen-antibody complexesbound to the solid phase are separated from unreacted and non-specificanalyte in solution, generally by centrifugation, filtration,precipitation, magnetic separation or aspiration of fluids from solidphases, followed by repeated washing of the solid phase boundantigen-antibody complex. Of particular interest are immunometric“sandwich” assays (Immunochemistry of Solid-Phase Immunoassay, John E.Butler, CRC Press, 1991) which first require binding of an immobilizedantigen or antibody with the target analyte from the biological sample.Separation of the immobilized pair and subsequent repeated washing isfollowed by the introduction of a secondary binding agent specific tothe analyte, said secondary binding agents usually being chemicallyconjugated with radioisotopes, enzyme, fluorescent or chemiluminescentlabels described earlier. Secondary binding agents are typicallyimmunoglobulin antibodies, antibody fragments, monoclonal antibodies orrecombinant antibodies. The analyte is “sandwiched” between the firstimmobilized antigen or antibody and the labeled secondary binding agent.A subsequent separation and washing is required to remove unboundlabeled secondary binding agents. Direct measurement of the labeled,immobilized bound complex or indirect measurement with the use ofsubstrates is then undertaken. It can be appreciated by those familiarwith the art of conducting solid phase immunoassays that the proceduresare laborious, time consuming and require special equipment or devicesfor separating immobilized binding agents and analytes.

Homogeneous assays are, in general, liquid phase procedures that do notutilize antigens or antibodies that are immobilized on solid materials.Separation and washing steps are not required. The procedures are morecommonly involved with the use of fluorescently-labeled antigens orantibodies which upon binding with a target analyte undergo anexcitation or quenching of fluorescence emissions, due to the closesteric proximity of the binding pair. Homogeneous methods have typicallybeen developed for the detection of haptens, small molecules, such asdrugs, hormones and peptides. Macromolecule analytes, such as proteinsor peptides with greater than 5000 molecular weight, usually are notdetermined by homogeneous methods due to a lack of assay sensitivities.A homogeneous method for detection of proteins was reported in U.S. Pat.No. 5,807,675 which required chemical modifications to both bindingagents, but is limited to the detection of single analytes.

For the diagnosis of allergy determination of total immunoglobulin Elevels is helpful, but more importantly there is a need for a convenientand reliable immunoassay method that simultaneously measures specificimmunoglobulin antibody levels to a panel of allergens, where one ormore allergens may be responsible for the onset of allergic symptoms. Itis further desired that the immunoassay protocol assay be easily carriedout and adaptable to automation. In vitro methods currently availableutilize heterogeneous immunoassay methods where separation and washingis required, making them labor-intensive, time-intensive and difficultto automate. It also would be advantageous to combine the versatilityand sensitivity of solid phase heterogeneous assay methods with the easeof a homogeneous protocol. Furthermore, conducting in vitro allergytests on a panel of allergens requires drawing a significant sample,generally 3-5 milliliters, of venous blood from the patient. Indeed, thepatient must visit a laboratory or physician's office for the singlepurpose of having the blood sample drawn.

Recent advances in immunoassay methods have introduced microtechniquesthat utilize smaller solid phases and smaller sample requirements. Oneexample is a microimmunoassay method for conducting analysis anddetection of multiple biomolecules that is described in U.S. Pat. No.5,981,180. Apparatus of this general type has been marketed by theLuminex Corporation under the trademark FLOWMETRIX. The technologyincorporates a flow cytometric procedure and the use of small, 5.6micrometer polystyrene bead sets, each set containing an internalfluorescent signature, that enables detection of multiple analytes. Forin vitro allergy testing, where specific levels of antibody are in lowconcentrations in circulating blood, undiluted blood or serum isrequired to enable the detection of antibodies that are at sub-nanogram-to picogram-per-milliliter levels. Up to now, heterogeneous rather thanhomogeneous immunoassay methods have been employed with existingin-vitro allergy testing methods, since undiluted blood or serum veryoften contains microgram levels of free or non-specific (total) antibodylevels which can interfere with determinations using homogeneous assays.

Homogeneous assay methods using undiluted blood or serum to measuresub-nanogram- or picogram-per-milliliter levels of antibody have beenknown to show falsely low or falsely undetectable levels of specificantibodies in samples where the free or non-specific antibody levels inundiluted serum are in the microgram per milliliter range. Such falseresults are known as a “hook effect”. The hook effect is described byRobard, D., (Radioisotopes: 37, (10), 1988), in the Immunoassay Handbook(Edited by David Wild, M Stockton Press 1994) and the Manual of ClinicalLaboratory Immunology (4th ed., Rose, et al., Editors) published by theAmerican Society for Microbiology (Chapter 2, page 5). It involves anunexpected fall in the amount of an analyte at the high end of adose-response curve, which results in a gross underestimation of theanalyte. The hook effect is caused by high concentrations of free, i.e.,unbound, analyte from neat serum or blood samples that bind to secondarybinding agents, depleting the availability of the secondary bindingagent to the solid phase bound analyte, subsequently rendering a falselylower signal, hence indicating a falsely low analyte concentration.Heterogeneous assay formats, specifically, immunometric sandwich assays,generally circumvent the interference with the separation and washingsteps inherent to the procedures.

The above-mentioned references suggest several ways that laboratoriescan deal with this hook effect. One suggested strategy is to run allpatient samples at two dilutions as a screen for this problem. If themore dilute sample indicates a significantly higher level of analyte,the laboratory is alerted to the possibility of a hook effect. Variousdilutions can then be carried out to provide an accurate determinationof the existing amount of analyte in the sample. Such procedures, ofcourse, result in duplication of work and lengthening of the time andcosts required to conduct testing of the sample from a given patient.Alternatively, large excesses of secondary binding agent, sufficient tobind both bound and unbound specific and non-specific analyte antibodycan be used. However, this approach has not proved practical due to thelarge concentrations of unbound specific and non-specific analyteantibody in undiluted blood, the relatively large serum or plasmavolumes typically required in conducting in-vitro allergy tests, and thecosts for secondary binding agent that would be used.

It would be advantageous to provide a homogeneous assay method fordetecting the presence of specific antibodies to a multiplicity ofallergens, simultaneously in a single test, or determining the total IgEantibody content in a blood sample, that would not be prone to theoccurrence of the hook effect. It also would be advantageous to providea method of testing blood samples from a patient for allergies thatcould eliminate the requirement that the patient visit a laboratory orphysician's office, as well as the need to have a fairly substantialamount of blood drawn for the purpose of this test. The inventiondescribed herein provides such advantages, as well as others that may beapparent from the information described.

SUMMARY OF THE INVENTION

Speaking very generally, this invention provides a method and a systemfor simultaneously detecting and quantifying levels of specificimmunoglobulin antibodies to a plurality of allergens, using a verysmall sampling of blood, for the purpose of diagnosing allergy. Theinvention also provides a method and a system for detecting andquantifying levels of total immunoglobulin E in such a small bloodsampling.

In general, the method of this invention comprises simultaneouslymeasuring specific immunoglobin antibody levels to from 2 to about 100allergens in a blood sample, said method comprising:

-   -   (a) collecting a blood sample of from about 10 to about 100 μL        from an individual;    -   (b) performing a homogeneous immunoassay on the blood sample or        a portion thereof, wherein the immunoassay is capable of        determining specific immunoglobin antibody levels to from 2 to        about 100 allergens; and    -   (c) determining the said specific immunoglobin antibody levels,    -   and the system comprises a system for simultaneously measuring a        plurality of specific immunoglobin antibody levels by use of a        homogeneous immunoassay, said system comprising:    -   (a) a plurality of particles coupled to from 2 to about 100        allergens;    -   (b) a first conjugate comprising an anti-human IgE or IgG        antibody conjugated to a first member of a specific binding        pair; and    -   (c) a second conjugate comprising a second specific binding pair        member that binds to the first specific binding pair member; the        system being capable of conducting simultaneous quantitative        determination of specific immunoglobin antibody levels to from 2        to about 100 allergens, by a homogeneous immunoassay.

The system and method thus enable, for the first time, the conducting ofsimultaneous determinations of a plurality (from 2 to about 100) ofallergens on a relatively small sample of blood.

One preferred method comprises a homogeneous immunoassay forsimultaneously detecting and quantifying specific immunoglobulinantibodies to a plurality of allergens in a blood sample, comprising:

-   -   (a) contacting a blood sample having a volume of from about 1 to        about 25 μL, preferably 1-10 μL, more preferably 1-5 μL, with a        plurality of particles coupled to a plurality of allergens, the        particles being in suspension in from about 1 to about 50 μL,        preferably from about 1 to about 10 μL, of an aqueous medium,        each combination of particles with a specific allergen being        distinguishable from combinations of the particles with other        allergens, under conditions whereby allergen-specific        immunoglobulin antibodies present in the blood sample bind        specifically to one or more of the allergens that are coupled to        the particles;    -   (b) thereafter contacting the materials from step (a) with a        first conjugate comprising an anti-human IgE or IgG antibody        conjugated to a first member of a specific binding pair, said        specific binding pair having the capability of amplifying        fluorescent signal output, under conditions whereby the        anti-human antibody binds to the immunoglobulin antibodies;    -   (c) thereafter contacting the materials from step (b) with a        second conjugate containing a fluorophore moiety coupled to a        second member of the specific binding pair under conditions        whereby the second member of the specific binding pair binds to        the first member of the pair; and    -   (d) thereafter measuring the fluorescence emitted by the        products of step (c).

A second method comprises a homogeneous immunoassay for detecting andquantifying total immunoglobulin E levels in a blood sample, comprising:

-   -   (a) contacting a blood sample having a volume of from about 0.5        to about 10 μL, preferably from about 1 to about 5 μL, more        preferably from about 1 to about 2 μL, with a plurality of        particles coupled to anti-human immunoglobulin E, the particles        being in suspension in from about 1 to about 50 μL of an aqueous        medium;    -   (b) thereafter contacting the materials from step (a) with a        first conjugate comprising an anti-human IgE antibody conjugated        to a first member of a specific binding pair, said specific        binding pair having the capability of amplifying fluorescent        signal output, under conditions whereby the anti-human antibody        binds to the anti-human immunoglobulin E;    -   (c) thereafter contacting the materials from step (b) with a        second conjugate containing a fluorophore moiety coupled to a        second member of the specific binding pair under conditions        whereby the second member of the specific binding pair binds to        the first member of the pair; and    -   (d) thereafter measuring the fluorescence emitted by products of        step (c).

Similarly, one system of this invention comprises a system forquantitative determination of specific immunoglobulin (IgE or IgG)antibody levels to allergens in a blood sample comprising:

-   -   (a) a plurality of particles coupled to a plurality of        allergens, the particles being in suspension in from about 1 to        about 50 μL of an aqueous medium, each combination of particles        with a specific allergen being distinguishable from combinations        of the particles with other allergens;    -   (b) a first conjugate comprising an anti-human IgE or IgG        antibody conjugated to a first member of a specific binding        pair, said specific binding pair having the capability of        amplifying fluorescent signal output, the first conjugate having        from 10 to 30 molecules, preferably 15 to 25 molecules, of the        first binding pair member conjugated to one molecule of the        anti-human antibody;    -   (c) a second conjugate comprising a second member that binds        specifically to the first member of the specific binding pair,        the second member being coupled to a fluorophore moiety;    -   (d) the mole ratio of first conjugate to the second conjugate        being from about 1:1 to about 1:5, preferably from about 1:1 to        about 1:2.

The invention further comprises a system for quantitative determinationof total immunoglobulin E levels in a blood sample comprising:

-   -   (a) a plurality of particles coupled to anti-human IgE antibody,        the particles being in suspension in from about 1 to about 50 μL        of an aqueous medium;    -   (b) a first conjugate comprising an anti-human IgE or IgG        antibody conjugated to a first member of a specific binding        pair, said specific binding pair having the capability of        amplifying fluorescent signal output, the first conjugate having        from 10 to 30 molecules, preferably 15 to 25 molecules, of the        first binding pair member conjugated to one molecule of the        anti-human antibody;    -   (c) a second conjugate comprising a phycobiliprotein and a        second specific binding pair member that binds specifically to        the first specific binding pair member;    -   (d) the mole ratio of the first conjugate to the second        conjugate being from about 1:1 to about 1:5, preferably from        about 1:1 to about 1:2.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a tabulated and graphical view of a specific IgE assay againsta panel of ten allergens according to the present invention inaccordance with Example 1

FIG. 2 is a tabulated and graphical view of a total IgE assay inaccordance with Example 2.

DETAILED DESCRIPTION OF THE INVENTION

This invention provides a method and a system for detecting andquantifying specific antibodies to allergens in a blood sample of anindividual, for the diagnosis of allergy. Heretofore, in vitro tests forallergy have employed immunoassay methods requiring venous drawsamplings of blood to enable testing on a panel of allergens. Typically,sample requirements of current methods, to determine levels of specificantibodies against a panel of five or more allergens, are from one tothree milliliters of blood. As compared to the prior art, the inventionlimits the sample volume requirements to ten microliters of sample orless, which can be used to test against two or more allergens,preferably against ten, twenty, forty or more allergens. The amount ofsample required is sufficiently small that individuals can remotelyobtain a blood sample using a fingerstick or similar procedure. Theinvention removes the need for obtaining blood samples by venous drawingprocedures at physicians' offices, hospital laboratories or clinicalreference laboratories.

In a preferred embodiment of this invention, the individual whose bloodis to be tested is provided with a kit for collecting and mailing, orotherwise submitting, the blood sample. The kit typically contains oneor more devices for puncturing the skin of a finger or other portion ofthe body (e.g., a “fingerprick” or “fingerstick” device) in order todraw some blood, an alcohol or other antiseptic swab for cleaning thearea to be punctured, a vial or other small container in which the bloodis to be put and sealed, and an appropriate container for mailing theblood sample to the laboratory for testing. The kit also may containadditional items such as adhesives to protect the wound, instructionalinserts and labels with individual identification numbers (e.g., PIN)for samples. In any case, the exact form and contents of such a kit canvary according to the desires of the laboratory and do not form a partof this invention. Numerous components for such kits are readilyavailable for collection and/or testing of blood (for instance, at home)for various purposes.

In addition, it should be noted that the providing of a blood sample bythe individual without visiting a physician's office or laboratory isnot a limiting feature of this invention, but only an advantage of it.The blood sample can well be taken during a visit to a physician'soffice, and submitted to a laboratory for testing. In such a case, otheradvantages of the invention, such as the ability to test a small samplewithout requiring dilution and/or duplication of tests, are achieved.

The use of such a limited sample volume essentially avoids the presenceof large amounts of free IgE antibody in the assay and the resultinghook effects that have heretofore been a barrier to homogeneous formatswith in vitro tests for allergy. In vitro testing methods for diagnosingallergy have heretofore employed heterogenous immunoassay methods, moregenerally, two-site immunometric sandwich assay procedures that requireseparation and washing steps to be performed. Neat serum, plasma orblood samples are also necessary in these procedures to attain thelevels of sensitivity required to determine blood circulating levels ofspecific antibody that are in the 10⁻⁹ to 10⁻¹² molar levels or in lownanogram/mL to picogram/mL range. Up till now homogeneous assays havenot been employed, due to high levels of specific and nonspecificantibody that are generally present in neat samples of blood fromallergic individuals, and the occurrence of the high-dose hook effect inthese assays. The invention provides an assay method that combines asolid phase sandwich immunoassay procedure with a homogeneous assayformat, where there is no requirement for separation of materials,washing, etc., and no requirement for sample dilution.

The assay method quantitates levels of total IgE and specific antibodylevels that are essential to allergy diagnosis and to the degree orseverity of allergic response to known allergens.

A preliminary step in carrying out the method and assembling the systemfor use in this invention is the preparation and collection of aplurality of solid particles coupled to a plurality of allergens so asto provide a panel of allergens to be tested, for instance, to determinewhether an individual's allergic symptoms are mediated by one or more ofthe allergens under investigation.

Each combination of particles with a specific allergen in the panel isdistinguishable from combinations of particles with other allergens. Aspecific allergen can be comprised of extracted proteins, proteinfractions purified by chromatographic or affinity chromatographicmethods, recombinant proteins or combinations of the above. Allergenmixes, such as two or more grasses, trees or foods, for example, canalso be utilized. The capability to distinguish between combinations ofparticles with different allergens is accomplished by providing aplurality of particles of different types. That is, the particles may bedivided into subsets, with each subset being distinguishable from othersubsets according to a particular property, characteristic orcharacteristics. For example, the particles may be divided into subsetswhere each subset is capable of being distinguished by a specific coloror emission spectra, which may be provided by the presence of afluorochrome or combinations of fluorochromes incorporated within or onit, for example, as described in U.S. Pat. No. 5,981,180. Each subset ofthe particles is coupled to a specific allergen so that, again, thecombination of particles with specific allergen is distinguishable fromcombinations of particles with other allergens, in accordance with theparticular characteristic or characteristics that distinguishes theparticle or bead in question from others that are used. The coupling ofthe allergens to the beads or particles is accomplished by covalentcoupling or adsorption methods well known to those familiar with the artand described in the patent and scientific literature (see, forinstance, Immunochemistry of Solid-Phase Immunoassay, John E. Butler,CRC Press, 1991 and Immobilized Enzymes, Antigens, Antibodies, andPeptides, edited by Howard H. Weetall, Marcel Dekker, Inc. New York,1975).

The particles themselves are typically spherical (i.e., “beads ormicrospheres”), with either a rough or a smooth surface, and areprepared as known in the art. They are made various materials, usuallynon-porous glass, polystyrene, latex or other polymeric materials, andare generally 0.05 micron to 90 micron diameter, preferably 0.5 to 10micron in diameter, with densities ranging from about 1 to 2 g/mL,preferably close to the density of water.

The particle/allergen combinations are preferably stored in a bufferedsolution containing a protein stabilizer and a bacteriostatic agent, foruse as desired.

Once the subsets of individual allergen/particles combinations areprepared, the subsets can be used individually or can be mixed togetherto form a single assemblage of allergens coupled to particles. This maybe done either in advance of conducting assays, so as to provide apreassembled panel of allergens for use in general, or may be done foreach individual assay, for instance, in case it is desired to tailor oneor more assays to the geographical location or environment of certainpatients. Particle concentrations can be determined and adjusted using aconventional counter and the desired number of particles for the assaycan be aliquoted. It is preferred that the number of particles insuspension be of limited quantity and in a limited volume to insureassay sensitivity, speed and adaptability to automated microassayformats (if an automated assay is to be used). The particles insuspension should be at a density close to that of water and suspendedin a buffered or aqueous medium sufficient in volume to allow molecularmotion and molecular contact and to be adaptable to microassay formats.

The panel for testing can contain, overall, as few as 2, preferably asfew as about 5, and up to about 100, specific allergens or mixtures ofallergens; however, panels of 10 to 40 allergens are more common. It ispreferred that for each test, the sample is added to a suspensioncontaining from about 1000 particles to about 4000 particles of each setof particle-coupled allergen or mixture of allergens, preferably in asmall volume, for example, a volume of from about 1 to about 50 μL,preferably from about 5-25 μL. Thus, for example, a test with a panel of10 allergens would contain about 10,000 particles in 5-20 microliters ofa buffered solution. Likewise a test with a panel of 20 allergens wouldincorporate about 20,000 particles in a 5-20 microliter volume.Increasing the number of particles in an assay decreases the amount oftime required to identify and read the particles.

The particles thus prepared are contacted with an individual's bloodsample. The blood sample will have a volume of from about 1 to about 25μL, preferably from about 1 to about 10 μL, and most preferably fromabout 1 to about 5 μL. Those familiar with the art will recognize thatbinding of analytes to antigens or antibodies is influenced byincubation conditions such as time, temperature, pH, ionic strength ofreagents, and the like, and the conditions of a given assay will bechosen as known in the art to optimize the sensitivity and specificityof the test and generally suit the ease of use of the protocol and itsadaptability to automation. In general, such conditions include atemperature of from about 18 to about 37° C., preferably ambienttemperatures of from about 18 to about 25° C., and a time of from about15 minutes to about 24 hours, preferably 1 hour or less. During thefirst incubation phase, specific antibodies from an individual's bloodsample will bind to specific allergens on particles through normalantigen-antibody binding forces. The suspension will contain both freespecific and free non-specific antibodies as well as particle-boundspecific antibodies.

For the determination of total immunoglobulin antibodies in a sample ofblood, anti-human antibody coupled to particles are contacted with anindividual's sample. The sample will have a volume of from about 0.5 toabout 10 μL, preferably from about 1 to about 5 μL, most preferably fromabout 1 to about 2 μL. Incubation times and conditions are determined asdescribed herein. In one embodiment of this invention, the test fortotal immunoglobins is capable of determining levels up to 4800 ng/mLtotal immunoglobins.

Then, a first conjugate comprising an antibody to the specific analyte,such as anti-human IgE, that is coupled to the first member of aspecific binding pair is sequentially added to the mixture. Separationof the solid phase particles from the reaction medium and sample is notrequired. The specific binding pair is a pair of molecules that havebinding specificity for one another. Examples of types of specificbinding pairs are biotin-avidin, biotin-streptavidin,digoxin-antidigoxin, and complementary homopolynucleotides poly(dA)-poly (dT) (described in U.S. Pat. No. 6,245,513). Thebiotin-streptavidin specific binding pair is a preferred embodiment ofthis invention. In a preferred embodiment a plurality of one member ofthe specific binding pair (e.g., biotin) is coupled (conjugated) to theantibody (e.g., anti-human IgE). The second member of the specificbinding pair, e.g., streptavidin, is coupled to a fluorescent label orfluorophore moiety, as described below. The binding of the secondspecific binding pair member, streptavidin, to the plurality of biotinsconjugated to antibody, amplifies the fluorescent signal, providinggreater assay sensitivity. Biotinylation of antibody can be carried outby techniques well known in the art. Typically, antibody-biotinconjugates either obtained commercially or prepared contain 5 to 10biotin molecules per antibody molecule. In this preferred application,optimum assay sensitivity is obtained when from about 10 to about 30biotin molecules are coupled per antibody molecule, preferably, about15-25 biotin molecules per antibody molecule.

Here again, those familiar with the art will recognize that binding ofanalytes to antigens or antibodies is influenced by incubationconditions such as time, temperature, pH, ionic strength of reagents,and the like, and the conditions of a given assay will be chosen asknown in the art to optimize the sensitivity and specificity of the testand generally suit the ease of use of the protocol and its adaptabilityto automation. In general, such conditions include a temperature of fromabout 18 to about 37° C., preferably ambient temperatures of from about18 to about 25° C., and a time of from about 15 minutes to about 24hours, preferably 1 hour or less. During the second incubation phase,secondary binding agents will bind to the analyte-particle complexthrough normal antigen-antibody binding forces.

Selection of the conjugates is done with an objective of enhancing assayperformance and sensitivity through a 10⁻⁹ to 10⁻¹² molar range withoutencountering fluorescent quenching and hook effects.

After a suitable incubation period of the first conjugate with theparticle and sample mixture, a second conjugate, containing the secondmember of the specific binding pair conjugated to a fluorophore, isadded to the mixture. The second binding pair member is preferablyavidin or streptavidin, most preferably streptavidin, though, asmentioned above, it may be anti-digoxin or materials described in U.S.Pat. No. 6,245,513. Covalent attachment of fluorescent labels to avidinor streptavidin may be effected by a variety of techniques previouslydescribed in patent and scientific literature (Haugland, R. P.,Bhalagat, M. K., Preparation of avidin conjugates, Methods Mol. Biol.1998; 80:185-96). Typical fluorescent moieties are described in Chapter3 of the Manual of Clinical Laboratory Immunology, supra. Alternativelythe conjugates may be obtained from a commercial sources. Fluorescentdyes such as fluorescein, the arylsulfonate cyanine dyes,phycobiliprotein dyes, bodipy dyes and the like, may be used. If theparticle subsets are distinguished from one another on the basis ofincorporation of fluorochromes, the dyes used in the conjugates areselected so as to have fluorescent emissions that are distinct from, anddo not interfere with, the emission spectra of the particle subsets. Apreferred type of fluorescent material is a class of compounds known asphycobiliproteins, more particularly the phycoerytherins, thephycocyanins, and the allophycocyanins, most preferably thephycoerytherins. Phycoerytherin conjugates have sensitivities rangingfrom five to ten times greater than that of corresponding fluoresceinconjugates, with quantum yields of up to 0.98 and extinctioncoefficients of up to 2.4 million (cm⁻¹ M⁻¹). Most preferred of these isR-phycoerytherin. In the second conjugate, the molecular ratio offluorescent dye to second binding pair member generally can range fromabout 1:1 to up to about greater than 5:10 with molecular weightsranging from about 300,000 to 3,000,000 or more daltons. The preferredmolecular weight of the second conjugate generally is about 400,000 toabout 1,000,000 daltons.

The materials are incubated under appropriate conditions for binding ofthe binding pair members. These, as are known in the art, typicallyinclude a temperature of from about 18° C. to about 45° C., preferablyfrom about 18° C. to about 25° C. and a time of from about 15 minutes toabout 24 hours, preferably from about 15 minutes to about 3 hours.

In this overall process, the fluorescently labeled antibodies bind tothe particles through the first and second binding partners, and throughthe binding of antibody to analyte antigen. They thus can be detectedand measured by application of excitation energy having a wavelengthselected to excite the chosen fluorescent label, where the emissionspectra that is generated is distinct from the emission spectraincorporated in the particles.

An important feature of the overall method of this invention is that theimmunoassay can be conducted without sample dilution. Furthermore, byenabling the use of small volume samples, a homogeneous assay formatwith solid phase particles, with appropriate assay range andsensitivity, is now possible.

In one embodiment of this invention, applicable to both specific andtotal immunoglobin assays, the individual who submitted the sample, oranother individual acting with his or her permission, can obtain accessto the test results over the Internet, or a similar global computersystem, for instance, from a Web site via a Web server.

As used herein, the term “Web server” may also refer to a plurality ofservers organized to handle a large number of requests for a Web server,i.e., a distributed Web server system. The term “Web site” is often usedto refer to a collection of Web servers organized by a business entityor other entity for their purposes. A user is said to “go to” or“access” a Web site when the user directs his or her Web client to makea request of one or the site's Web servers and display the response tothe user (even though the user and the Web client do not actually movephysically). The user perception is that there is a location on the Webwhere this Web site exists, but it should be understood that the term“Web site” often refers to the Web server or servers that respond torequests from Web clients, even though “site” does not necessarily referto the physical location of the Web servers. In fact, in many cases, theservers that serve up a Web site might be distributed physically toavoid downtime when local outages of power or network service occur.

The term “Web site” typically refers to a collection of pages maintainedby a common maintainer for presentation to visitors, whether thecollection is maintained on one physical server at one physical locationor is distributed over many locations and/or servers. The pages (or thedata/program code needed to generate the pages dynamically) need not becreated by the common maintainer of the collection of pages. Such amaintainer of the collection of pages is typically referred to as theWeb site operator.

The term “Web site” also includes Web sites connected to the Web clientsvia an intranet, wireless access protocol (WAP) network, a local areanetwork (LAN), a wide area network (WAN), a virtual private network(VPN) or another network arrangement. “Web” typically refers to “WorldWide Web” (or just “the WWW”), a name given to the collection ofhyperlinked documents accessible over the Internet using HTTP. As usedherein, “Web” might refer to the World Wide Web, a subset of the WorldWide Web, a local collection of hyperlinked pages, or the like.

In this embodiment of the invention, the submitter of the sample (orsomeone else having authorization from the submitter, such as arelative, physician or other care provider) can obtain access toinformation respecting the test results, on a Web site, Web “page” orthe like. A Web page typically consists of certain information. Webpages include both static pages and dynamic pages. Static pages arepages that are stored on the server, or in storage accessible by theserver, prior to the request and are sent from storage to the client inresponse to a request for that page. Dynamic pages are pages that aregenerated, in whole or in part, upon receipt of a request. For example,where the page is a view of data from a database, a server mightgenerate the page dynamically using rules or templates and data from thedatabase where the particular data used depends on the particularrequest made.

The submitter can be assigned a password or code (PIN) that permitsaccess to his or her test results on a web page or within a databasethat is maintained by, or for, the testing organization (e.g. testinglaboratory). Thus, in this embodiment a submitter may also receive thetest results without having to visit a physician's office, and may thenprovide such information to a physician of his or her choice, at his orher convenience.

Computer software that may be used to maintain, and provide access to,such test results, is available from vendors, and does not form a partof this invention.

The following assay procedure was used for all the examples describedherein.

a. Extracted allergens, typically from trees, grasses, molds, foods,danders and the like, are coupled to microparticles by covalent oradsorbed procedures. Each allergens extract is coupled to a uniquesubset of particles, with each subset distinguishable by an incorporatedfluorescent emissions or particle size where such differingcharacteristics can be recognized by appropriate instrumentation. Theallergen-coupled particle subsets are stored individually or the subsetsare combined as a panel of allergens in a buffered medium with proteinstabilizers and bacteriostatic agents. To determine specific IgE levelsto a panel of 10 allergens, for example, 10 μL of the combined particlesubsets, totaling 10,000 particles, each allergen particle subsetrepresented by 1,000 particles, are placed in a microfuge tube ormicrotiter well. For total immunoglobulin determinations, anti-human IgEis coupled to microparticles by covalent or adsorbed procedures, and1,000 particles are placed in a microfuge tube or microtiter well foreach test.

b. Blood, plasma or serum collected from an individual by means of thefingerstick collection kit as described herein, or other collectionmethods, is appropriately labeled or bar coded for identification. A fewdrops of collected blood, plasma or serum is adequate for determiningspecific antibody levels to a panel of allergens. A 5 μL sample is addedto the allergen-coupled particles residing in the microfuge tubes ormicrotiter wells. The combined mixture can be briefly vortexed (withmicrofuge tubes) or shaken (microtiter plate shaker) and incubated for 1hour at room temperature. For total immunoglobulin determinations, a 1μL sample is added to the anti-human IgE coupled particles residing inthe microfuge tube or microtiter well for each test.

c. Then, a volume of an antibody-biotin conjugate, as described, in abuffered solution, is added to the sample and the allergen-coupledparticle mixture described above. The total material is then brieflyvortexed or shaken again and allowed to incubate for 1 hour at ambienttemperature.

d. A volume of a streptavidin-R-phycoerytherin conjugate, as described,in a buffered solution, is then added to the mixture (c), and theresulting mixture is again briefly vortexed or shaken and allowed toincubate for 1 hour at ambient temperature.

Following this incubation, the resulting mixture of materials issubjected to a reading via appropriate flow cytometric instrumentation,such as the Luminex Corporation Luminex 100 System® or theBecton-Dickinson Immunosytometry FACSCAN® instruments, whichsimultaneously determines the particle subset by the particleincorporated fluorescent emissions or particle size and measures theemission spectra of the R-phycoerytherin attached to the particle viaantigen-antibody and biotin-streptavidin binding as previouslydescribed. To determine quantitative concentration levels of specificantibody to allergens, known standards, traceable to the World HealthOrganization standard (e.g., WHO IgE Standard 75/502 IU/mL), are run toprovide a standard curve, from which the concentration of specific IgEin a patient's sample for each allergen is extrapolated, recorded andreported. Specific levels of antibody to allergens can be reported inconcentration units, as for example, Units per milliliter and/or classlevels, as those acquainted with in vitro allergy diagnostics willrecognize.

The following are illustrative examples of the invention.

Preparation of Biotinylated Antibodies:

Biotinylated Anti-Human IgE:

To 15 μL of biotin (biotin amidocaproate N-hydroxysuccinimide ester)(Sigma, MO USA) 25 mg/mL in Dimethylformamide (Sigma) is added 0.4 mL ofaffinity purified anti-human IgE (Bethy Labs, TX, USA) 3.0 mg/mL in 0.1MNaHCO₃. The reagent solution is stirred for 1 hour at 25° C.Hyroxylamine (Spectrum Quality Products, CA, USA), 20 μL, 20 mg/mL in0.1M NaHCO₃ is added and the solution briefly mixed. The biotinylatedantibody solution is purified on a Sephadex G-25 (Pharmacia, Sweden)desalting column equilibrated with Phosphate Buffered Saline (PBS), pH7.2, containing 0.1% Sodium Azide (Sigma)

Covalent Coupling of Allergens to Particles—General Procedure

Carboxylated polystyrene microspheres (Luminex Corporation, TX, USA) aresuspended in 80 μL of 0.1M MES Buffer (Fisher Scientific, PA, USA) pH6.1. To the suspension is added 10 μL of N-Hydroxysulfosuccinimidesodium salt (Pierce Chemicals, IL, USA) 50 mg/mL and 10 μL of1-(3-dimethylaminopropyl)-3-Ethyl-carbodiimide hydrochloride (PierceChemicals, IL, USA) 5 mg/mL. The solution is vortexed and let stand inthe dark for 15-20 minutes at ambient temperature. The activatedmicrospheres are centrifuged for 5 minutes at 5000 g and the supernatantis aspirated. The microspheres are then resuspended in 250 μL of 0.1MPBS solution (0.1 M Sodium Phosphate, 0.14 M NaCl) pH 7.3. The mixtureis vortexed, the activated microspheres centrifuged and the supernatantaspirated as before.

The activated microspheres are then resuspended in 250 μL of allergenextract, purified proteins or recombinant proteins. Then the mixture isrotated (protected from light) for at least 1 hour at ambienttemperature and centrifuged for 5 minutes at 5000 g. The supernatant isaspirated and the microspheres resuspended in 250 μL of PBS/HSA BufferpH 7.3, containing 0.01 M PBS and 0.02 mg/mL Human Serum Albumin (Sigma,MO, USA), and vortexed to wash the microspheres of residual allergenextract. The supernatant is again centrifuged and aspirated aspreviously described. The wash procedure is repeated two more times andthe microspheres resuspended in 250 μL PBS/HSA. Microsphereconcentrations in solution is determined by counting using ahemocytometer (Fisher Scientific, PA, USA) and microscope (NipponKogaku, Japan).

Example 1 Assay for Specific IgE Levels to Allergens

Subsets of fluorescently labeled microspheres obtained from LuminexCorporation were covalently coupled with Alternaria mold, Bermuda grass,Timothy grass, Cat dander, Mountain Cedar tree, Egg white, Milk, Wheat,Ragweed and Mite extracted proteins. Serum samples obtained from atopicand non-atopic individuals were assayed against this panel of tenallergens. A 5 μL sample was added to 10 μL of suspendedallergen-coupled microspheres placed in V-bottom polypropylenemicrotiter wells (Evergreen Scientific, CA, USA) or 0.5 mL polypropylenemicrofuge tubes (Evergreen Scientific, CA, USA). For the six pointstandard curve, 5 μL of serum standards (secondary standards calibratedagainst the WHO IgE Standard 75/502) were each added to 10 μL ofantigen-coated microspheres in microtiter wells. The microtiter platewas placed on a microtiter plate shaker (Fisher Scientific, PA, USA) andshaken for 10-20 seconds. Microspheres with standards or sample wereincubated for 1 hour at room temperature as described above. A 40 μLvolume of anti-human IgE-biotin conjugate was added directly to thecontents in each well; the plate was briefly shaken as before and thecontents incubated for 1 hour at ambient temperature. Subsequently, a 40μL volume of streptavidin-R-phycoerytherin conjugate (AdvancedBiosystems, CA, USA) was added to the contents of each well andincubated for 1 hour at ambient temperature. The microspheres were thendirectly introduced to the Luminex 100 Flow cytometer for aspirationinto the instrument which simultaneously identifies the emission signalsof the subset particles and the presence of the R-phycoerytherinfluorescent label residing on the particles. The standard curve wasdetermined using a four parameter Lorentizian cumulative non-lineartransition function equation and levels of specific IgE to allergensinterpolated from the standard curve as shown in FIG. 1.

FIG. 1 shows the results from two non-allergic and three allergicindividuals with positive specific IgE responses to a panel of tenallergens. A 5 μL volume of sample from each individual was used in athree-hour homogeneous assay procedure to simultaneously measurespecific IgE levels to the ten allergens coupled to microspheres.Measurement of fluorescent intensity signals using the Luminex 100System was used to report the results in either IU/mL or class units asinterpolated from a six-point standard curve from 0.35 IU/mL. Responseinterpretations range from Negative to Extremely High based on classlevels obtained.

Example 2 Total IgE Assay

Goat anti-human IgE (B ethyl Laboratories, TX, USA) was coupled tomicrosphere particles (Luminex Corporation, TX, USA) following the sameprocedure described above for coupling allergens. Serum samples wereobtained from individuals obtained by the methods described above. A 1.0μL volume of standard (secondary standards calibrated against the WHOIgE Standard 75/502) or individual sample was added to 25 μL ofsuspended microspheres coupled with antibody in microtiter wells,briefly shaken as described above and incubated for 1 hour. A 40 μLvolume of anti-human IgE-biotin conjugate was subsequently added to thecontents of each well and incubated for 1 hour. Subsequently, a 40 μLvolume of streptavidin-Riphycoerytherin conjugate was added to thecontents of each well, the microtiter plate briefly shaken and themixture incubated for 1 hour. The microspheres were then directlyintroduced to the Luminex 100 Flow cytometer for aspiration into theinstrument which simultaneously identifies the emission signals of thesubset particles and the presence of the R-phycoerytherin fluorescentlabel residing on the particles. The standard curve was determined usinga four parameter Lorentizian cumulative non-linear transition functionequation and levels of total IgE in the samples interpolated from thestandard curve as shown in FIG. 2.

FIG. 2 shows the results of the Total IgE Standard Curve and Total IgEresults of ten individuals. A 1 μL volume of sample from each individualwas used in a three-hour homogeneous assay procedure. The amount oftotal IgE bound to anti-human IgE-coupled microspheres was determined bymeasuring the signal intensity from the fluorescent reporter signalsusing the Luminex 100 System and interpolated from a six-point standardcurve from 2-2000 IU/mL. Expected results on samples were provided by areference laboratory using an alternative essay procedure.

1. A system for a homogeneous immunoassay testing for an allergicresponse in a patient, comprising: a response mixture having anundiluted serum sample component from the patient with labeled subsetsof specific allergen-coupled particles under conditions that enablebinding of the allergen-coupled particles to allergen-specific IgEantibodies from the patient's serum sample; a first binding agentcomponent for adding to the response mixture, the first binding agentcomprising an anti-human IgE antibody covalently bound to a first memberof a binding pair; a labeled second binding agent for adding to theresponse mixture containing the first binding agent, the labeled secondbinding agent comprising a second member of the binding pair and alabel, wherein the second member of the binding pair has an affinity forbinding to the first member of the binding pair; an apparatus componentfor determining the amounts of the allergen-specific antibodies from theserum sample that are bound to specific allergens by (i) identifying anddistinguishing the labeled particles to identify the subsets of specificallergens and (ii) measuring the amount of labeled second binding agentin each of the subsets of allergens; wherein, the first binding agentand the second binding agent are preselected to enable detection ofanti-human IgE antibodies at a detection sensitivity ranging from about10⁻⁹ g/ml to about 10⁻¹² g/ml, and the undiluted serum is limited tohaving a volume of about 0.5 μL to about 25 μL; wherein, the molecularratio of anti-human antibody to the first member of the binding pair inthe first binding agent is from about 1:10 to about 1:30, the secondbinding agent has a molecular weight of between about 400,000 and about1,000,000 Daltons, and the selection of the first binding agent, thesecond binding agent, and serum volume has the function of avoidingquenching of a signal from the label of the labeled second binding agentand high dose hook effects; and wherein, the detection sensitivityranging from 10⁻⁹ g/ml to 10⁻¹² g/ml is measured under homogeneous assayconditions.
 2. The system of claim 1, wherein the labeled particles arefluorescently labeled microspheres, and the undiluted serum sampleranges in volume from about 1.0 μL to about 10 μL.
 3. The system ofclaim 1, wherein the first binding agent comprises an anti-humanIgE-biotin conjugate having about 15-25 biotin molecules per antibodymolecule, the second binding agent comprises astreptavidin-phycoerytherin conjugate, and the mole ratio of the firstbinding agent to the second binding agent ranges from about 1:1 to about1:5.
 4. The system of claim 1, wherein the labeled particles enableidentification of subsets of allergens, and the subsets compose a panelof allergens having from about 2 specific allergens to about 100specific allergens.
 5. The system of claim 1, wherein the system furthercomprises a kit having a device for puncturing the skin and obtaining ablood sample, and a container for holding and transmitting the bloodsample to a laboratory for extracting the serum sample and measuring theallergic response of the patient to an allergen or panel of allergens.6. The system of claim 1, wherein the system further comprises acomputer network component having testing results for the patient on anon- transitory computer readable storage medium accessible by thepatient to obtain testing results.
 7. The system of claim 1, wherein thefirst binding agent comprises an anti-human IgE-digoxin conjugate. 8.The system of claim 1, further comprising a flow cytometer.
 9. A systemfor a homogeneous immunoassay testing for an allergic response in apatient, comprising: a response mixture having an undiluted serum samplecomponent from the patient with labeled subsets of specificallergen-coupled particles under conditions that enable binding of theallergen-coupled particles to allergen-specific antibodies from thepatient's serum sample; a first binding agent component for adding tothe response mixture, the first binding agent comprising an anti-humanantibody covalently bound to a first member of a binding pair; a labeledsecond binding agent for adding to the response mixture containing thefirst binding agent, the labeled second binding agent comprising asecond member of the binding pair and a label, wherein the second memberof the binding pair has an affinity for binding to the first member ofthe binding pair; an apparatus component for determining the amounts ofthe allergen-specific antibodies from the serum sample that are bound tospecific allergens by (i) identifying and distinguishing the labeledparticles to identify the subsets of specific allergens and (ii)measuring the amount of labeled second binding agent in each of thesubsets of allergens; wherein, the first binding agent and the secondbinding agent are preselected to enable detection of anti-humanantibodies at a detection sensitivity ranging from about 10⁻⁹ g/ml toabout 10⁻¹² g/ml, and the undiluted serum is limited to having a volumeof about 0.5 μL to about 25 μL; wherein, the molecular ratio ofanti-human antibody to the first member of the binding pair in the firstbinding agent is from about 1:10 to about 1:30, the second binding agenthas a molecular weight of between about 400,000 and about 1,000,000Daltons, and the selection of the first binding agent, the secondbinding agent, and serum volume has the function of avoiding quenchingof a signal from the label of the labeled second binding agent and highdose hook effects; and wherein, the detection sensitivity ranging from10⁻⁹ g/ml to 10⁻¹² g/ml is measured under homogeneous assay conditions.10. The system of claim 9, wherein the labeled particles arefluorescently labeled microspheres, and the undiluted serum sampleranges in volume from about 1.0 μL to about 10 μL.
 11. The system ofclaim 9, wherein the first binding agent comprises an anti-humanantibody-biotin conjugate having about 15-25 biotin molecules perantibody molecule, the second binding agent comprises astreptavidin-phycoerytherin conjugate, and the mole ratio of the firstbinding agent to the second binding agent ranges from about 1:1 to about1:5.
 12. The system of claim 9, wherein the labeled particles enableidentification of subsets of allergens, and the subsets compose a panelof allergens having from about 2 specific allergens to about 100specific allergens.
 13. The system of claim 9, wherein the systemfurther comprises a kit having a device for puncturing the skin andobtaining a blood sample, and a container for holding and transmittingthe blood sample to a laboratory for extracting the serum sample andmeasuring the allergic response of the patient to an allergen or panelof allergens.
 14. The system of claim 9, wherein the system furthercomprises a computer network component having testing results for thepatient on a non-transitory computer readable storage medium accessibleby the patient to obtain testing results.
 15. The system of claim 9,wherein the first binding agent comprises an anti-human antibody-digoxinconjugate.
 16. The system of claim 9, wherein the allergen-specificantibodies from the patient's serum sample are allergen-specific IgGantibodies, and the anti-human antibody in the first binding agent is ananti-human IgG antibody.
 17. The system of claim 9, further comprising aflow cytometer.
 18. A system for a homogeneous immunoassay testing foran allergic response in a patient, comprising: a response mixture havingan undiluted serum sample component from the patient with labeledsubsets of specific allergen-coupled particles under conditions thatenable binding of the allergen-coupled particles to allergen-specificIgG antibodies from the patient's serum sample; a first binding agentcomponent for adding to the response mixture, the first binding agentcomprising an anti-human IgG antibody covalently bound to a first memberof a binding pair; a labeled second binding agent for adding to theresponse mixture containing the first binding agent, the labeled secondbinding agent comprising a second member of the binding pair and alabel, wherein the second member of the binding pair has an affinity forbinding to the first member of the binding pair; an apparatus componentfor determining the amounts of the allergen-specific antibodies from theserum sample that are bound to specific allergens by (i) identifying anddistinguishing the labeled particles to identify the subsets of specificallergens and (ii) measuring the amount of labeled second binding agentin each of the subsets of allergens; wherein, the first binding agentand the second binding agent are preselected to enable detection ofanti-human IgG antibodies at a detection sensitivity ranging from about10⁻⁹ g/ml to about 10⁻¹² g/ml, and the undiluted serum is limited tohaving a volume of about 0.5 μL to about 25 μL; wherein, the molecularratio of anti-human antibody to the first member of the binding pair inthe first binding agent is from about 1:10 to about 1:30, the secondbinding agent has a molecular weight of between about 400,000 and about1,000,000 Daltons, and the selection of the first binding agent, thesecond binding agent, and serum volume has the function of avoidingquenching of a signal from the label of the labeled second binding agentand high dose hook effects; and wherein, the detection sensitivityranging from 10⁻⁹ g/ml to 10⁻¹² g/ml is measured under homogeneous assayconditions.
 19. The system of claim 18, wherein the labeled particlesare fluorescently labeled microspheres, and the undiluted serum sampleranges in volume from about 1.0 μL to about 10 μL.
 20. The system ofclaim 18, wherein the first binding agent comprises an anti-humanIgG-biotin conjugate having about 15-25 biotin molecules per antibodymolecule, the second binding agent comprises astreptavidin-phycoerytherin conjugate, and the mole ratio of the firstbinding agent to the second binding agent ranges from about 1:1 to about1:5.
 21. The system of claim 18, wherein the labeled particles enableidentification of subsets of allergens, and the subsets compose a panelof allergens having from about 2 specific allergens to about 100specific allergens.
 22. The system of claim 18, wherein the systemfurther comprises a kit having a device for puncturing the skin andobtaining a blood sample, and a container for holding and transmittingthe blood sample to a laboratory for extracting the serum sample andmeasuring the allergic response of the patient to an allergen or panelof allergens.
 23. The system of claim 18, wherein the system furthercomprises a computer network component having testing results for thepatient on a non-transitory computer readable storage medium accessibleby the patient to obtain testing results.
 24. The system of claim 18,wherein the first binding agent comprises an anti-human IgG-digoxinconjugate.
 25. The system of claim 18, further comprising a flowcytometer.